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F �RMIT APPLICA�Ii�N � <br /> CITY OF kVFRETT PERMIT SER`�fICES ,�y�i,�� �y� <br /> 3200 CFDAR STREET, EVERETT, �NA 98201 � � <br /> 425-257-881[)— FAX 425-257-8857—www.ever�tb.va.org I <br /> APPLICATI'OhS ARE AC;CEPTED FROM 8 AM TU A FfM _ _ ^ ` _ _ _ _ i <br /> SITE AUC!RESS ! PARCEL TAX l.D.# Pfi`i'A!(R-_ <br /> =�g�� c��ra,��� �:b � c5o4102U000b100 _.� `� '-i;%/`-�j <br /> LE�hL LOT NO. OLOCK TP;;CT OR SUBDIVISION# � <br /> DESC. <br /> OWNER AD�RESS CIT`l/ZIP PHOHF. <br /> 1��� `�-Hi?F_1 ':;' 'r f���. u;� �050 �:�'�cl�S �'ZIO ��'�tL=. �-zr�a GCNc�E� <br /> C�O�> �24• szo5 <br /> TENANT NAME CONTACT FOR PERMIT . PHONE /-�2S ��O OC�7I'� <br /> CVIZC��L�1J I`Il,�'(�U'y-- �QCW� I N I N� � E•MAIL <br /> CONTRACTOR ADURESS ITYIZ P H <br /> k �'7LC�-1r���IC/�- L1L . � �'�X Z�IOZ'k- `.����'LL= WA �I�1Z�1- <br /> CONTR.LICENSEp ��.M���� J`�Z�� Il^ \G�/�;� <br /> 7� �S.�J �C/v�.=_ �2�OJ Iv✓�t�� <br /> USE OF BUILDING �1 HEAT SOURCE CONTRACT PRICE OF WORK <br /> }�Ll%IL --�� I - �;,/��'"�/ _Elec�ric x Gas_Other �T� 3�10�cV <br /> / — <br /> WORK DESCRIPTION <br /> T3L��OvL NON' S�UG�V��11_, Wccv� 1=2�ML= 7���1�'IC.ti� <br /> PLUMBING MECHANICAL ( <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC-air handling units <br /> Balhtub Forced air sys�ems <br /> � Lavalory(wasli basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer ' <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Bacf,tlow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease irap Woodslove <br /> Roof drains Olher <br /> Other <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3195 <br /> I hemby certi(y ihat I have read and examined this applicalion and know ihe same lo be true and correcL All provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give au)horily to violate or cancel the provision of any olher state or local law regulating construclion or the peAormance of <br /> conslryc[i . Thal I am authorized by lhe owner o(�his property�o peAorm ihe work for v�hich application is made and t comply with the <br /> Slal �Cont c rs Law 18.27 RCW and 296.200 WAC. <br /> ��' /� / <br /> Signature o wnerlConlraclor/Authorized Agen� ate ( /z <br />